Assessing Changes in Relational Continuity of Care Among Adults with Vulnerable Housing in a Transitional Case Management Program
Continuity of Care
Transitional Case Management
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AbstractBackground: Individuals with vulnerable housing commonly experience barriers to health and social care. Connect 2 Care (C2C) is a case management intervention that connects people with vulnerable housing and high acute care use to community-based care. Relational continuity of care, a proxy for stable patient-provider relationships, is associated with improved patient outcomes in the general population. We assessed whether adults with vulnerable housing experience improved primary care use and relational continuity following C2C engagement, and evaluated predictors of improved continuity. Methods: We used practitioner claims data to conduct a pre-post cohort study with 390 adults engaged with C2C. Participants must have been homeless or vulnerably housed, had ≥3 emergency department presentations or ≥2 hospitalizations within the past year, and ≥3 primary care visits pre- and post-C2C for continuity analyses. We examined changes in the proportion of low primary care users (<3 visits/year) using McNemar’s test. Relational continuity was measured at the provider and site level using the Usual Provider of Care (UPC) and Continuity of Care (COCI) indices. We performed paired t-tests to compare continuity within the year pre- and post-C2C and multivariable logistic regression to identify characteristics associated with improved continuity. Results: Of 390 participants, 220 had ≥3 primary care visits pre- and post-C2C and 116 were low primary care users. Following C2C engagement, the proportion of low primary care users significantly decreased by 15% in absolute terms and continuity of care significantly increased. Pre- to post-C2C, there was a mean increase of 0.04 in provider- and site-UPC. Similar increases were observed for the COCI, though only the increase in site-COCI was significant. Stratified analyses demonstrated no differences in effect on care continuity in subgroups across 11 patient characteristics and we did not identify characteristics associated with increased continuity following C2C engagement. Significance: Our results suggest that Connect 2 Care was associated with improved primary care use and relational continuity of care among individuals with vulnerable housing. These findings add to our understanding of how primary care access may be improved using case management interventions in this population.
CitationChiew, A. (2022). Assessing Changes in Relational Continuity of Care Among Adults with Vulnerable Housing in a Transitional Case Management Program (Unpublished master's thesis). University of Calgary, Calgary, AB.
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